Fibrinogen and D Dimer in Healthy Nigerian Women on Hormonal Contraceptives
Keywords:
fibrinogen, D dimer, hormornal contraceptive, haemostasis
Abstract
Introduction: Hormonal contraceptives have been associated with increased tendency of thromboembolic disorders. However, a balance between fibrin generation and fibrinolytic activity has been shown to minimize the risk. The aim of the study was to assess the serum fibrinogen and D-Dimer level in hormonal contraceptives users. Methods: A total of 160 consenting participants made of 80 subjects on different forms of hormonal contraceptives and 80 controls on non hormonal IUCD were recruited into this study. A structured questionnaire was administered to obtain information required; blood samples were collected from each of the participant into appropriate containers using standard methods. Fibrinogen assay was done using the STAGO STart®4 coagulation analyzer while D-dimer was measured using ZYMUTEST DDIMER ELISA kit (HYPHEN BioMed). The results were analyzed using SPSS version 17.0 software. Statistical significance was based on p value < 0.05. Results. The mean fibrinogen levels of the study group and controls were 387.10±62.52 and 276.85±52.70 respectively, (reference range 180-400ng/ml). The mean D dimer concentrations of the study group was markedly elevated 813.36±212.35 while that of the controls was 257.04±108.33 (reference range <400). Both analytes showed a statistically significant difference between the study group and control (P<0.05). None of the client on COCP has elevated D dimer level. Conclusion: The significant increase in the procoagulant protein- fibrinogen and corresponding increase in fibrinolytic activity as demonstrated by elevated Ddimer level reflect a balance between fibrin formation and degradation hence minimizing the VTE risk. This balance is less prominent with use of COCP and can be attributed to the oestrogen component.References
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14. Ahmed JA, Muna AK. Effect of combined oral contraceptive pills on some haemostatic parameters. Ann. Coll. Med. Mosul 2007; 33 (1&2): 66-69.
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17. Meijers JCM, Middeldorp S, Tekelenburg W, et al. Increased Fibrinolytic activity during use of Oral Contraceptives is counteracted by an enhanced Factor XI-independent down regulation of Fibrinolysis: a randomized cross-over study of two low-dose Oral Contraceptives. Thromb Haemost 2000; 84: 9-14.
18. Famodu AA. Serial changes in plasma fibrinogen concentration and fibrinolytic activity in African women on oral contraceptive pills. Afr J Reprod Health. 1997; 1: 90-95.
19. Kuhl H, März W, Jung-Hoffmann C, Heidt F, Gross W. Time-dependent alterations in Lipid Metabolism During Treatment with Low-dose Oral Contraceptives. Am J Obstet Gynecol 1990; 163: 363- 369.
20. Kenneth AB, Gregory YH. Overview of the causes of VTE- oral and transdermal contraceptives available at http//www.update.com/content/overview of venous thrombosis. [Accessed 30th January 2013].
21. Cameron CT, Richard JC, Alan DM et al Hormonal Contraception and Thrombotic Risk: A Multidisciplinary Approach. Pediatrics. 2011; 127(2): 347-357.
2. Cardiovascular Disease and Steroid Hormone Contraception: Report of a WHO Scientific group. WHO Tech Rep Ser 1998; 877: 1-89.
3. Factsheet for women taking hormonal contraceptive or who will like information about them. BUPA’s health information team publication, May 2010.
4. George PC. Hormonal contraception. In Betram GK (ed). Basic and clinical pharmacology. McGraw-Hills Companies New York. 9th ed 2006; 673- 678.
5. Joseph JT, Abdulazeez AA, Obisesan OA. Effect of hormonal contraceptives on some haemostatic parameters in women attending family planning clinics in Jos, Nigeria. Nigeria journal of health and Biomedical Science. 2008; 7 (1): 15-18.
6. Vandenbroucke JP, Koster T, Briet E,Reitsma PH, Bertina RM, Rosendel FR. Increased risk of venous thrombosis in oral-contraceptive users who are carriers of factor V Leiden mutation. Lancet. 1994; 344: 1453- 1457.
7. Family planning: National Population Commission (NPC) and ICF Macro. 2009. Nigeria Demographic and Health Survey 2008: Key Findings. Calverton, Maryland, USA: NPC and ICF Macro. 5-6
8. Aliyu AA, Shehu AU, Sambo MN, Sabitu K. Contraceptive knowledge, attitudes and practice among married women in Samaru community, Zaria, Nigeria. East Afr J Public Health. 2010 Dec; 7(4): 342-344.
9. Knowledge and use of modern contraceptives among Muslim women in Zaria, Nigeria. Available at iussp2005.princeton.edu/papers/50788. [Accessed 27th January 2013].
10. Babatunde AS, Olatunji PO. Short term effect of oral contraceptive pills on some haemostatic parameters in healthy Nigerian women. The Nigerian Postgraduate Medical Journal.2004; 11 (4): 246 -250.
11. Aisien AO, Enosolease ME, Shobowale MO. Evaluation of haemostatic function in Nigerian Norplant® acceptors after 12 months of use. J Obstet Gynaecol. 2005; 25 (4): 377 - 381.
12. Ajayi O, Ajayi O. Obarhua E. Haemostatic Evidence of Thrombotic Signaling in Nigerian Women on Injectable Contraceptives. Haematologica 2007; 92[suppl.2]:434.
13. Prasad RN, Koh S. Ratnam SS. Effects of three types of combined O.C. pills on blood coagulation, fibrinolysis and platelet function. Contraception. 1989; 39(4): 369-383.
14. Ahmed JA, Muna AK. Effect of combined oral contraceptive pills on some haemostatic parameters. Ann. Coll. Med. Mosul 2007; 33 (1&2): 66-69.
15. Chan P, Paul CJ, Pan WH. Influence of Contraceptive pill use, Premenopausal and Postmenopausal State on Haemostatic Parameters in Ethnic Chinese Women: Journal of Thrombosis and Thrombosis and Thrombolysis. 1996; 3: 9-12.
16. Winkler UH. Blood coagulation and Oral Contraceptives: a Critical Review. Contraception. 1998; 57: 203- 209.
17. Meijers JCM, Middeldorp S, Tekelenburg W, et al. Increased Fibrinolytic activity during use of Oral Contraceptives is counteracted by an enhanced Factor XI-independent down regulation of Fibrinolysis: a randomized cross-over study of two low-dose Oral Contraceptives. Thromb Haemost 2000; 84: 9-14.
18. Famodu AA. Serial changes in plasma fibrinogen concentration and fibrinolytic activity in African women on oral contraceptive pills. Afr J Reprod Health. 1997; 1: 90-95.
19. Kuhl H, März W, Jung-Hoffmann C, Heidt F, Gross W. Time-dependent alterations in Lipid Metabolism During Treatment with Low-dose Oral Contraceptives. Am J Obstet Gynecol 1990; 163: 363- 369.
20. Kenneth AB, Gregory YH. Overview of the causes of VTE- oral and transdermal contraceptives available at http//www.update.com/content/overview of venous thrombosis. [Accessed 30th January 2013].
21. Cameron CT, Richard JC, Alan DM et al Hormonal Contraception and Thrombotic Risk: A Multidisciplinary Approach. Pediatrics. 2011; 127(2): 347-357.
Published
2018-11-28
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